Fraud Awareness
Fraud
- False claim – death: Claims received for a death that has not occurred.
- False claim – disability: A disability claim received where the life assured has not experienced any trauma and is not disabled according to the terms and conditions on his or her policy.
- Forgery – Forging claim forms
- Non-disclosure: Not disclosing previous medical conditions and then attempting to claim for these conditions while on the policy.
- Misrepresentation of unnatural death:
- Suicide
- Homicide
- Hazardous Activities
- False claim: Claiming for services that were never performed.
- Card Sharing: Allowing a non-member to use the membership card for treatment.
- Medicine Dispensing fraud: Where generic medicine is dispensed and the claim is received for the original drug at a higher cost.
- Conniving with medical providers – receiving unnecessary medical treatment or getting payments for treatment not received
- Exaggerating of claims: Submission of a valid claim, with inflated costs or additional items are added, which were never stolen.
- Driving a vehicle whilst under the influence of alcohol or drugs: Falsification of state of mind when accident occurred.
- False loss: Claiming for the loss of a specified item that the client never owned, or that was not really lost.
- Causing further damage to items: A genuine loss occurred, however the client does not want the item repaired and causes further damage to the item in order to get a replacement.
TIP Offs
First Mutual subscribe to Deloitte’s Tip-Off Anonymous, a whistle blowing service
All Stakeholders are encouraged to report theft, corruption, fraud and inappropriate workplace behaviour. The identity of the whistle-blower will be kept anonymous through a random number that is allocated.
Deloitte Tip Off Anonymous Hotline
Telephone Toll Free: 0800 1400 to 4106
Toll Free Econet: 0805 5500, 4461
Toll Free NetOne: 0716 800 189 /190 or 0800 4146
Email: reportszw@tip-offs.com
Website: www.tip-offs.com
Postal Address: The Call Centre, P.O Box HG 883, Highlands, Harare
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